THE 'STEM' HOLY GRAIL

01-December-2018

RAJGOPAL NIDAMBOOR

Medicine has turned full circle — right from the idea of prevention and aiding the mind and body to overcome illness. Aristotle would be smiling, because his credo of ‘seamless’ relationship that exists between body and soul is being increasingly used in medical treatment — that human health is ‘harmonious‘ balance. This is not merely a biological evolution; it is also the basis of physiological setback. This bids fair to a whole, new awakening in medicine, which includes stem cell-based research and therapy to repair and/or replace damaged organs, or constituents, in the human system without the need for transplant procedures.

Scholars believe that Charles Darwin's Origin of Species should have been a part of medical education, a vade mecum, ever since it first appeared in print, over 150 years ago. This is simply because medicine would have focused on the individual having the illness, and not one’s external symptoms alone. This would have also placed medicine and therapeutics on a lofty, elevated pedestal — to treat the whole person, not just the affected part, or system. It would have made medicine simple, not complex as it was for ages. It would have ‘humanised’ the basis of new advances, including revolutionary healing techniques, such as stem cell research and regenerative therapy.

Stem cell therapy is emerging as the ‘Holy Grail’ of contemporary medical treatment. What are stem cells? Stem cells are a class of undifferentiated cells that are able to ‘differentiate’ into specialised cell types. They are ‘derived’ from two key sources — embryos formed during development [embryonic stem cells] and adult tissue [adult stem cells]. They do not serve any one function; they have the competence to serve any function, after they are ‘coached’ to specialise. Every cell in the body, for example, is derived from the first few stem cells formed in the early stages of embryological development. Stem cells extracted from embryos can, as a result, be ‘coached’ to become any desired cell type. This makes them influential enough to regenerate damaged tissue under the right conditions. This is also one major reason why stem cells hold exciting new possibilities in medical research and advanced, super-specialised treatment of disease.

Stem cell research and therapy are as exciting as they are composite; they also appear too far-fetched with overzealous proponents. The realities, therefore, are not as realistic as they ought to be; besides, the stem cell rhetoric is at its peak, so also media and advertising hard sell. It is high time stem cell-based regenerative therapy, the new kid on the block, is regarded and evaluated without bias in terms of ethical issues and primacy. This also explains why cutting-edge treatment options, like stem cell therapy, as some clinicians observe, are ‘heroic,’ all right. They argue that conventional wisdom is, by itself, well endowed with adequate tools — aspirin and anti-hypertensives, to highlight one example — to manage and control heart disease. The protocol also has a good clinical record of safety, economics of scale and effectiveness, when promulgated with effective preventative measures, such as healthy diet, regular exercise and relaxation.

Put simply, stem cell therapy does not represent definitive endeavours; it mirrors broad categories with essential concepts relating to uniformity, sometimes lurking beneath science, sometimes above science, or beyond the realms of science. Hence, the questions are as exciting as the therapy per se. What disease states stem cells can address, what diseases can be targeted, what patients benefit, what cost, or how does stem cell therapy compare in terms of the options available? Or, what should be the prime goal for changing the course of innate illness states, such as diabetes in children, or restoring the heart from physiological distress to effective function, or restoring the spine after injury to its pristine healthy state, or ‘replacing’ damaged muscles in heart disease? The answers are just as groundbreaking, because stem cell therapy offers tangible, positive outcomes in alleviating suffering. It proclaims a noble pursuit in the service of humanity — also, improving health and providing a better quality of life. In other words, stem cell therapy has all the bearings to add life to your years, not just years to your life.

This is the positive side of stem cell research. The downside is stem cell therapy is no magic wand — whatever the progress, stem cell-based research cannot be quick, notwithstanding all the media hype and hoopla. It is also far too ‘keyed up’ in the West, or the developed world — not the developing world. There is also, in addition, opposition for human embryonic stem cell research, especially with religious leaders and beliefs. This is, perforce, the raison d’être for top-heavy attention for stem cell research.

This brings us back to the basics — that prevention of chronic degenerative diseases, through lifestyle and dietary changes, is any day better than the most miraculous of cures. This is simply because one must understand that every pie spent on stem cell research may not be spent on research alone — because it may not so much deal with the health needs of susceptible populations, or on cost-effective, optional treatments.

While it is agreed that stem cell therapy could ease the damage caused by disease, many critics, biologists and clinicians are not enthused about the fact that the therapy could ‘turnaround’ the immune system. What’s more, the immune system is a big worry in terms of ‘tapping’ the clinical efficacy of stem cell-based therapies. Though stem cell therapy is touted as a ‘sure cure’ for type-1 diabetes, it is awfully restricted, because augmenting the functional beta-cells is no ‘manna’ to rectifying the ‘causal’ autoimmune dilemma. Besides, when functioning normally, immune scrutiny ‘taps’ the unsuitable explosion of stem cells; this undermines the therapeutic intent. Yet another drawback is the emergence of a tumour — a direct spin-off of stem cells when they propagate out of context, beyond immune control. This is precisely why most current stem cell therapy protocols incorporate advanced steps to circumvent tumour-related concerns, or issues.

Realistically speaking, stem cells could be therapeutically employed to counter spinal injuries and chronic degenerative disorders, or ‘diseases of affluence,’ such as type-2 diabetes and coronary heart disease that cause a high proportion of morbidity and mortality. This is not all. Stem cells research and therapy are now a booming area in dentistry. Dental stem cells have been employed to treat periodontitis and dental caries — this has spawned a new generation of treatments, aside from dental research. All of this does not, however, percolate to the developing world for want of funds — if not intent. To return to the paradox, or old argument — the prevalence of erroneous lifestyle factors and chronic degenerative diseases in wealthy nations does not affect people as much as their counterparts in the underdeveloped world. This is because access to effective and superior healthcare more than recompenses for the damage caused by lifestyle factors.

New research suggests that transplantation of stem cells from the spleen, liver, or bone marrow have the therapeutic potential to treat type-1 diabetes. Stem cells from the spleen have been shown to reverse diabetes in mice, when autoimmunity was kept in ‘suspended animation.’ It is still early days, although new-fangled approaches to emendate possible snags and ‘encapsulate’ stem cells, while protecting them from immune assault and permitting insulin ‘surge,’ have yielded optimistic results.

This applies to heart disease, no less, the difference being of degree — especially in cases where patients with ventricular remodelling and dysfunction cannot be treated without surgical intervention. Existing treatment with medications, bypass surgery, or angioplasty, is limited. This is where proponents of regenerative stem cell therapy are buoyant and confident. This is because of nature’s marvellous design — human heart cells are capable of recompensing, although they can’t ‘self-heal,’ when there is extensive tissue damage due to heart disease. This is precisely where stem cells ‘emerge’ with the ability to provide heart patients that ‘cape’ of good hope — a whole new lease of life.